+Annual Dues Form

ANNUAL MADISON ASSOCIATION DUES
Name___________________________________________________________________
Wife’s Name (for Assoc. Membership and/or our records)______________________
Address________________________________________________________________
Phone #___________________________E-Mail________________________________
Yrs. on Board _______________Crew______ Rate/Dept.________________________
Amount Paid $_______________________Yr./Yrs/ Pd. For______________________
If no dues have ever been paid, the first year is $20. Thereafter, dues are $10 per year. (If not sure, contact Secretary, at fchuwe@cheqnet.net, who maintains a current list.) Associate Members (Wives) are $10 per yr. (We are limited by the IRS to 25% of our membership for Assoc. Members; therefore it is first come, first serve.) If you wish to be paid in advance, add $10 for each year and note above.
Make check payable to: USS JAMES MADISON ASSOCIATION, INC.
Mail to: Don Hix, Treasurer : 4911 Albert Lane, Rapid City, SD 57703
PLEASE REMEMBER, by being a paid member of the Association, you are helping to finance the continuation of the USS James Madison SSBN627 Association and the reunions it sponsors.